3. Print schedules for current business day. Verify that all patients are assigned to a student and doctor. Give copies of schedule to attending faculty and at pre-designated secure common locations. Prepare sign-in sheet for students.

4. Prepare sign-in sheet with current date. All patients must sign-in upon arrival.
Remove strip and attach to the schedule once
patient registration is complete. Once the staff member has assisted the patient, black out the name on the sign in sheet for anonymity. Sign-in sheet should be monitored throughout the day to ensure a timely check-in for each patient.

5. Each person at the front desk will have a $100 cash bag. Verify the $100 before opening, and after closing. Each staff member must verify their own cash bag at opening and closing without exception. Staff must report discrepancies to Center management immediately.

-Maintain log of patients in the Center and their Center Directory status.

Answering the telephone

We always like to be as helpful and courteous as possible when answering the telephone. Keeping an upbeat tone of voice is more welcoming to the caller. The front desk staff give the first impression / contact that the outside public has with the Center for Eye Care.

Script to use when answering the phone: University Eye Center, this is _____, how may I help you?

SCHEDULING

1. Find out if the patient is an established or new patient. A patient seen more than 3 years ago will be considered a new patient for billing purposes, but still use the current file. Check to make sure if the patient is loaded in Eyecare Advantage. There are times when a patient makes an appointment, but doesnt keep the appointment so that the information is already in Eyecare Advantage. If you find the name but with a different address, determine if they ever lived at the address in the database.

2. Determine what type of appointment the patient needs: Primary Care exam, CL exam, Pediatrics etc. If the patient states they want an annual exam please clarify if they are a Contact Lens wearer. If so their exam needs to be in the Contact Lens department.

3. Verify the number of available interns and patient slots before confirmation of appointments.
Make every attempt to schedule the patient with the faculty member who had seen the patient at the previous visit.

4. Schedule appointments according to established protocol. Enter patient's name, address, telephone number, date of birth, email address, sex and insurance information. Patients with insurance must bring a current insurance identification card and also a picture identification care at the time of the appointment. A copy must be scanned in the EMR file. Benefits and eligibility must be verified before any appointment is scheduled. This information must be documented in the patient's EMR file.

5. If the patient has Medicaid as their insurance, eligibility must be verified while they are on the phone. There is a web-based site on each of the computers for the Missouri locations. If you are unsure how to read the Medicaid verification report, please ask the Center Supervisor.

6. In Eyecare, click on appointments and daily detail. The appointment screen will appear. Select site, attending and service. The software requires that the appointment will be scheduled with a doctor that is a provider for the patient's specific insurance.

7. When quoting appointment times to the patient, always tell them that the appointment time is 15 minutes prior to the actual appointment time in Eyecare. Do not advise the patient you are booking them 15 minutes ahead of time (this will help to keep our schedule on time). For example if we have an 8:30 am slot the patient is to be told 8:15 am.

8. Make sure the financial agreement has been met over the phone (insurance information provided or they understand payment is due at the time of service for a self-pay) Ask the patient if they are associated with the University or if they have insurance benefits. If so make sure to advise them we need to have a copy of their insurance card or University affiliated card (Faculty / Staff / Student / Alumni ID).

9. Once the agreement has been met on the appointment time, thank the patient and then re-confirm their appointment time. Ask patient if they would like to receive a confirmation call the day before their appointment.

10. Telephone patients that have not kept their appointment to re-schedule. In the remarks section of the patient's appointment, mark the result of the phone call to reschedule the patient.

11. At the University Eye Center there are numerous departments we schedule: Primarily 3rd year students - Primary Care; Primarily 4th year students - Contact Lenses, Pediatrics/Binocular Vision (& the Pupil Project), Low Vision, Refractive Management, EHMS, and Electrodiagnosis. During the winter semester the third year student will have a half day schedule in both Pediatrics/BV and Contact Lenses.

12. At the off-campus sites: Optometric Center, East St. Louis and Harvester both the 3rd and 4th years will see all of the patients. They will divide up patients with more complex needs to the 4th year students as they are available.

13. Dispensary has their own schedule. Patients do not need an appointment to order glasses. Once the patient checks in they are added to the dispensary schedule and a superbill is printed. Patients will be called in the order of sign-in.

CHECK-IN

1. After the patient has signed in, remove the signed strip and start the check in process. Give any necessary paperwork to the patient to fill out or update. Check the file to make sure an updated Notice of Privacy Practices has been signed and the HIPAA Directory Consent Form is acknowledged within the past year.

2. Ask the patient if they are associated with the University as staff, faculty, alumni or student. If so, they are eligible for discounts on services and materials. If they are not inquire, about any insurance plans. If they do not have any coverage then they will become a self-pay.

3. Print patient registration information from Eyecare. Verify all established patient demographics. Enter any changes or new information in Eyecare.

4. Obtain all insurance cards and scan them into Eyecare Advantage. Once the patient is opened on the screen, click on the insurance company that corresponds to the card, place the card face down and click scan. Do the same for the back side of the card. If it is their identification card (Drivers License) add "Drivers license" as an insurance company and follow the same process.

5. Highlight your schedule sheet so you are aware who has checked in.

6. Take the forms from the patient and check to make sure everything is legible and complete. Check to make sure an authorization number is in Eyecare Advantage.

7. Print the superbill and at the same time arrive the patient in Eyecare Advantage. Arriving the patient is very important as the students are graded on how long they are with the patient. When the patient checks out we must depart them (same procedure as arrive).

8. Page the student so they can begin their examination with the patient.

CHECK-OUT

1. Depart the patient in Eyecare Advantage. Mark the patient out on the schedule.

2. Take the completed superbill from the student:

a. Check for signatures, student, doctor, patient, diagnosis code (Medicare  must be a medical code, no refractive code unless there is no medical code. If it is refractive, Medicare will not pay so the patient is responsible).

b. Appropriate treatment is marked. Ask if any additional tests were done (photos, etc.). If it is not marked the attending needs to mark this, not the student.

c. Confirm the accuracy of the patient account for any association with the University as a staff, student, faculty, alumni or if they have any private health insurance.

d. Calculate and verify total patient charges on the superbill. Review superbill for accuracy and completeness, including all signatures, diagnosis codes, and fees. Inform attending faculty of discrepancies. Collect appropriate fees from the patient. A patient is considered a new patient if they have not been seen in 3 or more years. Review the superbill for legibility. If the doctor or student name can not be read, print the name(s) on the superbill.

3. Obtain a fee adjustment waiver for any non-routine adjustments, e.g., educational, at checkout. These should be erlatively rare occurrences. The attending faculty must sign this fee adjustment form. Fee adjustments associated with negotiated agreements (e.g. for UMSL faculty, staff, students, alumni) do not require a fee adjustment form, but a photocopy of a current, valid ID must be placed in the patients EMR. Refer to the Center for Eye Care discount policies for additional information.

4. Before totaling the superbill ask if the patient will be ordering glasses or contacts. If so, hold off on totaling until all the charges have been marked. Have the student take the patient to the dispensary if they are getting glasses. If the dispensary staff is busy the student should wait with the patient unless they have another patient waiting. If so, they should ask the patient to wait in the waiting room and advise the dispensary staff there is a patient waiting and leave the file with them.

5. If the patient is not ordering glasses, add the total charges, discounts if applicable and total the superbill. Collect the payment.

a. Collect all co-payments for insurance patients

b. Collect co-payments for straight Medicaid for members over the age of 21. HMO Medicaid typically do not have a co-payment unless it states this on the Medicaid strip that was run prior to the appointment and when the patient arrived for the appointment.

6. VSP / VBA  what is on the voucher is what the patient pays.

7. Make sure totals are printed legibly.

8. Make the next appointment (if applicable).

9. Give receipt to the patient (top copy  original is kept for filing, 2nd copy (yellow) is for the patient, bottom copy (pink) goes to the dispensary if glasses or contacts are being ordered, if not it is to be destroyed.

10. Once the patient has checked out, mark out next to their name on the schedule.Change appointment status to "K" in Eyecare.

11. Superbills are to be tallied and reconciled at the end of day and placed in the Center Manager's folder for audit.

2. It is the policy of the Center for Eye Care that the release of medical information related to treatment must have a signed authorization by the patient, legal representative, or legal guardian before any information is released. This authorization must be placed in the patient's record. Verification of the patient by photo ID or signature is required. Before any records are sent outside the Center for Eye Care, the Center Manager or Assistant Dean for Clinical Programs must approve them. Records coming from the remote sites should send in the copies and request for verification before mailing.

3. Release of PHI for reasons not related to TPO must have a signed patient authorization.

4. Release of medical information to legal firms and agencies can be processed provided an authorization has been signed by the patient or legal guardian. There is a minimum charge of $16.50 plus $0.37 per page according to state statue for this service. Documentation and duplication of medical records to vocational and rehabilitation agencies is processed upon written request from the agency. There is a $21.50 charge per report, unless otherwise negotiated. Seek approval from Center Supervisor before releasing any medical record information.

CLOSING

1. Closing begins 15-20 minutes prior to scheduled leaving time. A front desk staff member must be present until all patients are checked-out (this may require staff remaining later than scheduled time, which will be adjusted off on another day).

2. Run a tape on the calculator totaling charges, payments, and adjustments, creating a receipt. Put your superbills in numerical order.

3. Run a tape on the calculator for cash, checks, credit cards, and total, creating a deposit receipt. Put this calculator tape with cash, checks, copy of checks and credit card receipts and superbills in a manila envelope marked with the current date, staff members name, and the total deposit.

4. Put all superbills in numerical order. Record beginning and ending numbers on the superbill log for the day, and initial. Record the number of missing superbills, noting intern / attending faculty. Notify Center management of missing superbills. A superbill must be generated for every patient. There are NO exceptions.

5. Verify $100 in cash bag. Drop deposit envelope and cash bag in safe (if someone will be coming to the front desk to relieve a staff member, the relief person drops the $100 cash bag). Each staff member must verify their own cash bag. There are NO exceptions. Any shortages or overages must be reported to the Center Manager immediately.

7. Close and lock external doors at appropriate closing time.

8. Make sure that Eyecare Advantage has been exited at each exam room computer work station and the work station has been brought to the login position (ctrl-alt-del).

9. Close all exam room windows and lock all internal doors.

10. Check the "Shred" folder in the faculty/student conference room

11. Lock file room.

12. Clock out of Eyecare Advantage.

13. Turn off all lights.

14. Set alarm.

Guidelines for Typical Scenarios

To enter the Eyecare Advantage Computer System, you must have an ID and password. See Center Manager to obtain this.

To search for a patient:

Click on search at the top of the screen, which allows you to search by name, account number, SSN, DOB, Phone number and account responsible. If you want to search by name a quicker way is to click on the magnifier icon (1st on the left of the screen). Type in the last name and first name if you know it and then search. Choose which patient you need by double clicking.

Insurance:

Obtain all insurance information  Name of the carrier, address, phone number, ID and group numbers. Be sure to find out from the patient how to bill them for their visit and if there is a co-pay.

Lions Club / Indigent Funding:

There is a 3 ring binder to keep a copy of these authorizations. The original authorization should be kept in the file and a copy placed in the 3 ring binder for follow up purposes. On a weekly basis the authorizations are to be reviewed and reconciled in Eyecare Advantage so proper billing can proceed. If the patient has been authorized, but not seen in the clinic the patient is to be called and scheduled for an appointment.

Miscellaneous Activities:

Check the next days schedule for patients that are missing information. Obtain information and enter it into the system (missing insurance information, address, zip code etc).

Close and lock doors at the appropriate closing times.

Send out confirmation letters.

Send out recall letters.

Call patients for an appointment that have not responded to the recall letters.

Check folders for the necessary paperwork.

Break down the no show folders.

DISPENSARY

STANDARD OPERATING PROCEDURES

1. Frame selection

a) Frames must be chosen from the appropriate frame board, as determined by any third party payer program.

b) Try to sell a stock frame.

c) If the patient must have a different size or color combination than what is available from stock, write the complete information on the lab order form and mark it "to be ordered". Complete frame information, including style name or number, manufacturer, supplier, eye size, bridge size, temple, length and color.

d) Inquire about environments in which eyewear would be worn.

e) Utilize polycarbonate or protective eyewear as needed.

f) Fill out Eyecare Rx screen completely, including Rx, lens style, material, seg heights, PD's, and any lens tints or treatments. Post the charges into Eyecare Advantage, assigning the proper charges to the patient and/or insurance company along with the diagnosis. Verify that the proper doctor and student have been posted to the charge, for insurance filing and reporting accuracy.

g) Be sure to ask the patient how they could be reached during business hours to notify them that their glasses are ready.

h) Write the frame and lens prices on the superbill using the Eyecare Advantage pricing pre-calculation system which links the price with the Rx. Make sure all add-on charges are also written on the superbill. All Medicaid orders are to be posted once the glasses are dispensed to the patient.

i) Explain the frame and lens charges to the patient.

j) Explain to the patient that it will take about 5 business days after the required payment is made before the glasses are ready and that the Center staff will call after proper verification. Patients with insurance must pay the co-pay, deductible and/or add-on charges in full before an order is processed. Self-pay patients must pay 100% of the bill at the time of order.

k) Take the patient and the superbill to the front desk to check out. When the check-out process is completed, thank the patient for their order.

l) Put the pink copy of the superbill, the lab order form and the frame in a tray in the dispensing lab. Write the patient's last name and first initial, and the date on a white name slip and put it in the tray.

2. Ordering

a) Print two (2) order forms for the lab from the Eyecare Advantage screen. Verify that all necessary information is on the order form (name, date, Rx, lens material and design, pd, seg height, frame)

b) Check order form to see if a special order frame and/or sunglass clip is required. If so, call in the order. Use the patient's last name and first initial as a reference so that it will appear on the invoice that arrives with the frame. Check to make sure that the frame company has that frame and/or sunglasses in stock. If not in stock, get the expected delivery date and notify the patient of the delay.

c) When enclosing a stock frame, remove its price tag, place the frame in a job envelope with the top copy of the order form. Place the sealed job envelope in the lab box for laboratory courier pick up.

d) Create a dispensing tray with patient name and date of the order. Place a copy of the spec order superbill and lab order form in the tray.

e) Place the tray on shelf marked "orders at the lab."

f) Record job order on "Rx log."

g) Monitor trays daily. If after one week the job has not returned from the lab, call the lab and write a note and place it in the tray.

h) For remakes, write reasons and original date of purchase.

i) When second superbills are generated for orders that were not done at the initial patient visit, sign the superbill, complete the diagnostic code from the examination.

If no payment or deposit was made:

a) Put tray on the "on hold" shelf. Mark hold on the name tag. Write the date payment is expected. If payment is not received by that date, call the patient to find out when payment will be received. Do not hold and order for more than two weeks. If no payment is received by then, the frame is returned to the board. The patient will have to choose a new frame and place a new order if they come back to do so.

b) Place Medicaid orders and any other third party payer orders that require prior authorization on the "hold" shelf. Contact the proper 3rd party payor authorization. Please post any authorization numbers in Eyecare Advantage for billing purposes. Complete medical necessity forms as required.

a) Complete the frame log with manufacturer's name, frame number and other information when frame is received. Enter the frame into Eyecare Advantage inventory.

b) Complete the lab log with order date, lens design, date sent to lab, date returned from lab, date verified and date patient called. When ordering frames, mark the frame as ordered in the Eyecare inventory module.

c) When a frame arrives from supplier, make entry in the frame log, label and place on the appropriate frame board. Enter the frame into inventory, print a tag with the bar code label.

d) When special order frame arrive, wrap frame in the lab order form and place in the appropriate location for laboratory courier pick-up.

e) Process invoice when glasses return from the laboratory. Check accuracy of invoice. Stamp invoice with patient financial information. Obtain patient payment information from Eyecare Advantage and determine its consistency with the lab invoice. Mark the cost on the invoice. If the patient has insurance and a co-pay (e.g. VSP) note this on the invoice in the payment section of the stamp. Verify prescription by ANSI standards. Place glasses in an appropriate eyeglass case in the patient dispensing tray with a copy of the lab order form. Place invoice in lab folder to be attached and reconciled with monthly statement.

f) Return glasses to laboratory if ANSI standards are not met.

g) At spec pickup, dispensary staff gives spec order superbill to the front desk for filing.

h) At the beginning and end of every work day inspect frame boards. Re-stock frames at the end of the day. Maintain reasonable vigilance of frame boards throughout the work day. At the beginning and end of the day fill out the frame log of how many frames were sold, how many were replaced and determine if any frames are missing. If theft is suspected, notify the appropriate law enforcement agency and make an accurate report. Notify Center management immediately.

i) For frame repairs write in the comment box of the superbill what was done.

13. current space available for frame niches that is superior to currently placed frames (i.e. viability of product sales) based on the above characteristics

STANDARD OPERATING PROCEDURES FOR BILLING

CENTER FOR EYE CARE

1. Patient accounts are billed monthly, insurance accounts are billed weekly. Three attempts will be made to collect balances before the billing Department Specialist enters a bad-debt write-off on the patient account for non response/payment. Small balances will be written off at the discretion of the Department Specialist and/or the Fiscal and Business Operations Specialist (BFOS). A note is entered in the patient electronic record of action taken and reason. The front desk staff will attempt to collect any balances if a patient returns for a future appointment.

2. Each individual claim must be reviewed for accuracy and either electronically submitted or mailed the day of billing.

3. After receipt of remittance advisory with a listing of rejected claims, the following must be entered into Compulink Advantage patient notes: date of remittance

date of service

reason for rejection

action taken

date of claim re-submission if applicable

4. Compulink Advantage patient notes must be updated after payment is received or final denial decision is made. (Do not over-write previous Compulink Advantage notes).

6. Unpaid claims of 60 days or older must be reviewed and followed-up with third party payers.

7. Compulink Advantage patient notes must be updated after follow-up with the following:

individual claim representative contacted

resolution

date of re-submission of claim

8. Billing staff non routine activities, exceptions, notable events, and any billing questions should be shared with the Department Specialist.

9. Recurrent billing problems must be reported to department specialist in a timely and accurate fashion.

10. Any written or verbal correspondence or communication from outside agencies must be reported and shared with the Department Specialist.

11. An aging report will be generated monthly by Department Specialist and reviewed with billing staff.

12. Billing updates from outside agencies and third party payers will be reviewed by Department Specialist and Center Manager as received and changes communicated to the billing and front desk staff.

13. Remittance files will be maintained by individual payer by calendar year.

14. Summaries of billing activities, adjustments, write-offs, and accounts receivable will be discussed and reviewed by the Department Specialist and BFOS on a regular basis.

15. The billing staff, Department Specialist and Center Manager should be available to the front desk staff as a resource for questions about patient insurance coverage eligibility or related issues.

16. The Center Manager should be available to review with the front desk staff patient insurance eligibility at the time of appointment.

17. Billing department will keep Medicare, Medicaid and other and/or newsletters and bulletins available in the Billing Office. The billing staff should visit these websites on a regular basis. They should also subscribe to e-mails and electronic news services.

18. All write-offs must be approved by Department Specialist. Uncollectable balances one year and older will be written off regardless of individual amounts. Patient small balances, those $10.00 and less, will be written off after two collection attempts are made.

20. All refunds must be approved by the Department Specialist when requested by the Center Manager or other CEC administrative staff. All supporting documentation must be attached to the refund request. They include patient ledger, payment method and a description of the reason for the request.

21. Paper financial records will be managed according to the latest University of Missouri System Records Retention Guide.

STANDARD OPERATING PROCEDURES FOR POSTING INSURANCE PAYMENTS

CENTER FOR EYE CARE

1. The Center Department Specialist receives payments by mail. The checks are sorted by Center site.

2. The Center Department Specialist endorses checks after sorting, using the University stamp before the checks are given to the billing staff for posting.

4. If the check amount and the Compulink daysheet and/or payment report do not match the remittance advisory is checked line-by-line to identify the line of posting error. Once the error is corrected the amounts should be reconciled.

The standard for billing patient services requires Center billing staff to review and evaluate the completed medical record prior to the submission of any charges. While billing practices for patient services vary, the prevailing standard in most physician offices and clinics is to ask for payment at the time the services are rendered or to submit a bill to the patient's carrier at the end of the day. It is not practical to expect every patient record to be 100 percent complete when the patient leaves the Center.
The following additional instructions are to be used in conjunction with existing guidelines and regulations for professional billing:

1) Completed attending notes will be in the patient medical record within seven working days of the patient encounter.

2) Center staff may submit professional charges for non-procedural clinic encounters before a complete written attending note is in the record as long as:

a. there is sufficient evidence in the record that a billable patient encounter occurred

b. the billing attending has provided a clinical diagnosis and treatment plan, and

c. the billing attending has chosen a level of patient encounter that the staff feels is likely to be supported by the clinical diagnosis and plan.

3) Center staff may only submit professional charges for patient procedures on the basis of a recorded description of the procedure in the medical record. For purposes of Part B billing, the note must be authored by the provider who performs the procedure and conforms to current documentation requirements.

4) The Business and Fiscal Operations Specialist and Assistant Dean for Academic Affairs and Clinic Programs will perform periodic random reviews to be certain all documentation is completed. All Medicare claims must be reviewed before submission for payment.

STANDARD OPERATING PROCEDURES FOR CLAIMS REJECTION ANALYSIS

CENTER FOR EYE CARE

The Compliance Officer has received questions regarding areas of concern when the Center staff performs an analysis of a rejected claim to determine if error caused the rejection and, if so, will correction lead to re-submission of a valid claim. This advisory memo is intended to assist the individual who is attempting to find the appropriate answers.

The following principles apply; it is assumed that those individuals involved in claims rejection analysis will be knowledgeable of ICD-9-CM and CPT coding:

1) All retrospective claims analysis that results in re-submission of the claim or write-off of the charge must document the justification for any and all changes made to the claim. Claims rejected for reasons that amount to simple clerical error at the time of original submission do not require review by the billing attending. Examples of such error might include keystroke error, incorrectly assigning the order of diagnoses on a reporting form, or the matching of diagnoses to procedures on a reporting form.

2) All other changes to claims prepared for re-submission will document the justification for any changes and these changes must be approved by the providing attending. A process must be in place to preserve the record of the changes and the corresponding approval. Changes in diagnosis or procedural codes would be examples of such changes requiring provider approval. These changes must be supported by the medical record as it existed at the time of service.

3) All post-submission claim reviews must be based on the medical record that existed contemporaneously with the date of service for which the claim is submitted. Under no circumstance will any rejected claim be analyzed and re-submitted on the basis of a late or otherwise altered entry in the medical record made for purposes other than supporting or clarifying patient care or changes to the actual date of services or provider.

4) The process should identify a contact person in the Center (usually the Department Specialist – Billing) who can respond to requests to review ICD-9 and CPT codes and other issues on claim denials or rejections.

5) The Business and Fiscal Operations Specialist and/or Center Manager will attest to the qualifications of those Center staff who they know are qualified to be allowed practice management software access to perform adjustment and re-submission of rejected claims. A copy of this attestation should be sent to the Compliance Officer.

6) The Business and Fiscal Operations Specialist and/or Center Manager will forward to the Compliance Officer a copy of the Center’s process for documenting any changes to charges.

7) It is strongly recommended that the Center process for claims analysis and re-submission include a provision for supervisory review prior to re-submission of the claim.

8) The Center staff is reminded that re-submission of a claim is never required. The providing attending and Department Specialist, the Chief Billing Clerk and the provider always have the option of acknowledging the validity of the denial as a reason to write-off the charge.

STANDARD OPERATING PROCEDURES (Time & Labor) FOR BI-WEEKLY STAFF

CENTER FOR EYE CARE

Time & Labor was implemented on November 29, 2009. This comprehensive online payroll process allows employees to enter time worked, requests for time off, and absences. These entries will then be reviewed and approved electronically. This online process eliminates the need for paper-based time tracking. Data entry into WebTime will no longer be available to UM-St. Louis departments beginning with the implementation on November 29th. All staff members must use Time & Labor.

Employees are categorized into these three important roles in Time & Labor:

Time Reporters are employees who enter time worked and absences directly into the Time & Labor module. This includes employees who are paid biweekly and monthly, as well as hourly employees who are paid monthly. Salaried employees will only enter absences.

Time Approvers are managers and other supervisors who review and approve timesheets and absences.